tbuckley/cabot-search huggingface dataset:
Abstract 13643: Examining the Association Between Social Determinants of Health and Health-Related Quality of Life Among Children With Cardiac Conditions
Authors: Colin J Crilly, Priya Sharma, Vicky Tam, Christopher Smith, Jie Tang, Yoav Dori, Matthew J Gillespie, Andrew C Glatz, Michael L Obyrne
Journal: Circulation (2022)

Introduction: Patient-reported outcomes like health-related quality of life (HRQOL) measure the health and well-being of patients, providing insights not communicated by traditional outcomes. The degree to which social determinants of health (SDOH) influence HRQOL is under-studied. Methods: A cross-sectional analysis of subjects aged 8-18 years referred for cardiac catheterization from 1/1/18-12/31/21 was performed, evaluating the association between HRQOL (measured through child and caregiver-proxy reports of cardiac-specific HRQOL (Pediatric Cardiac Quality of Life Inventory (PCQLI)) and general HRQOL (Pediatric Quality of Life Inventory (PedsQL))) and a panel of potential SDOH. Potential SDOH measures were calculated at subject’s neighborhood level by linking their addresses to block group/census tract data. SDOH measures included Childhood Opportunity Index, which measures neighborhood resources supporting child development, and Social Deprivation Index, which measures neighborhoods’ levels of disadvantage. Linear regression was used to evaluate the association between SDOH and HRQOL (PCQLI and PedsQL total scores), adjusting for presence of cardiac symptoms (New York Heart Association Class). Results: In total, 111 subjects (age 12.8±2.9 years, of which 89% identified as White, 5% Black, and 8% Hispanic, and 27% Medicaid-insured) were studied. Primary cardiac diagnoses included single ventricle heart disease (19%), complex biventricular repairs (20%), and orthotopic heart transplantation (12%). The majority (69%) denied having symptoms. Out of a potential 100, subject-reported scores were 67±18 on the PCQLI and 74±19 on the PedsQL. Caregiver-proxy reported scores were 70±17 on the PCQLI and 71±19 on the PedsQL. Worse SDOH was consistently associated with lower HRQOL adjusted for presence of symptoms (Table 1). Conclusions: Worse SDOH was associated with worse HRQOL in pediatric cardiac patients independent of symptoms severity
Abstract 13652: A Randomised Double-Blind Placebo-Controlled Study of Fenofibrate as a Metabolic Modulator to Augment Cardiac Physiology in Moderate-Severe Aortic Stenosis
Authors: Shveta Monga, Ladislav Valkovic, Saul G Myerson, Stefan Neubauer, Masliza Mahmod, Oliver J Rider
Journal: Circulation (2022)

Background: Pressure overload in aortic stenosis (AS) is associated with reduced cardiac fatty acid oxidation (FAO) and evidence of myocardial steatosis and impaired myocardial energetics. Here, we investigated whether modulating myocardial metabolism to increase FAO with a PPARα agonist, Fenofibrate in moderate-severe AS had effects on cardiac metabolism and physiology. Methods: 67 participants with asymptomatic moderate-severe AS were prospectively randomised (double-blinded) to receive either Fenofibrate 200mg once daily (N= 54) or placebo (N=13) for 6 months (180 ± 7 days duration). Follow-up data is available in 42 patients. Primary endpoint was reduction in myocardial triglyceride content (MTG) measured using proton magnetic resonance spectroscopy (MRS). Secondary endpoints included cardiac PCr/ATP measured by 31P-MRS and LV strain assessed using MR tagging. Results: There was significant reduction in MTG content (-0.40%, CI -0.74 to -0.06, p= 0.022), with a no significant reduction seen in placebo. (-0.46%, CI -1.1 to 0.17, p= 0.13). A significant increase in venous butyrate levels was seen in the fibrate group (+0.09 mmol/l, CI 0.006 to 0.17, p= 0.036) in line with increased fatty acid oxidation. No change in cardiac energetics was seen in either group. No change in cardiac function was seen in either group, global longitudinal strain (-0.07%, p 0.89 Fibrate vs -0.31%, p 0.67 Placebo), circumferential strain ( -0.15 %, p 0.80 Fibrate vs 1.71%, p 0.07 Placebo). Conclusions: Fenofibrate can potentially upregulate fatty acid oxidation in hypertrophied AS hearts reducing myocardial lipid content, but this did not have any measurable beneficial physiological effect in moderate-severe AS.
Abstract 14179: Unsupervised Machine Learning on Myocardial Deformation Curves Identifies Specific Clusters of People at Risk of Heart Failure - The Copenhagen City Heart Study
Authors: Jakob Oeystein Simonsen, Daniel Modin, Kristoffer G Skaarup, Kasper Djernæs, Mats Lassen, Niklas D Johansen, Sergio Sanchez, Brian Claggett, Jacob Marott, Magnus Thorsten, Gorm Jensen, Peter Schnohr, Rasmus Mogelvang, Tor Biering-Srensen
Journal: Circulation (2022)

Background Peak global longitudinal strain is recognized as a powerful predictor of heart failure (HF). However, whether the entire strain curve add important prognostic information regarding risk of HF remains unknown. We aimed to investigate whether patterns of myocardial deformation identified through unsupervised machine learning (uML) entailed additional information regarding risk of HF. Methods Longitudinal strain curves from 3,710 subjects from the general population without prevalent HF were clustered by similarity using uML based on strain curves alone. The grouped clusters were then compared by incidence rate of HF and in multivariable COX models. Results Mean age was 56 years and 43% were male. During a median follow-up of 5.3 years, 92 subjects (2.5%) developed HF. The uML algorithm generated a hierarchical clustering tree (Figure 1) and 10 different clusters. Generally, with increasing incidence of HF, strain curves displayed a smaller reduction of strain from peak-GLS to the maximal curvature during the early filling relative to the size of their peak-GLS (Figure 1 and 2): We called this value early diastolic strain to peak-GLS (EDS to peak-GLS). One exception was cluster 9. In multivariable Cox regression, cluster 9 was significantly associated with increased incidence of HF when compared to cluster 3,4 and 5 [For cluster 3: HR 6.6, 95%CI: 1.5;29.0, p = 0.013] even though the subjects of cluster 9 were younger (40 years), displayed healthier clinical baseline characteristics, and only had slightly reduced Peak-GLS. The mean strain curve of the lateral basal segment of cluster 9 displayed an early systolic lengthening followed by a late and reduced contraction specifically related to the basal lateral segment (Figure 3). Conclusion uML could identify clusters with high incidence of HF based on strain curves alone. The algorithm identified unknown strain patterns beyond peak-GLS presumably related to increased risk of HF.
Abstract 13006: Association of Changes in Interstage Monitoring Practices and Transcatheter Intervention for Recurrent Coarctation Following the Norwood Operation
Authors: Ari J Gartenberg, Oluwatimilehin Okunowo, Christopher Smith, Andrew C Glatz, Yoav Dori, James W Gaynor, Christopher Mascio, Jonathan J Rome, Matthew J Gillespie, Michael L O'Byrne
Journal: Circulation (2022)

Introduction: Intensive interstage monitoring has been associated with lower mortality between the Norwood operation and superior cavopulmonary connection. This may be due to early identification of residual anatomic lesions like recoarctation before lasting harm occurs. Methods: Neonates undergoing a Norwood and followed interstage at a single center from 1/1/2005-9/18/2020 were studied. The exposure was Norwood date divided into 3 eras: 1. pre-interstage monitoring; 2. early era of monitoring; 3. current era. We evaluated the association of era and likelihood of hemodynamic insult (≥moderate ventricular dysfunction/AV valve regurgitation, initiation/escalation of vasoactive/respiratory support, cardiac arrest preceding cath, or interstage death with coarctation on autopsy) in subjects with recoarctation. We also analyzed whether era was associated with technical success in transcatheter recoarctation interventions, procedural major adverse events, and transplant-free survival. Results: 483 subjects were studied, with 22% (n=106) treated for interstage recoarctation. Number of catheterizations per Norwood increased ( p =0.005) with no significant change in the proportion of subjects with recoarctation ( p =0.36). There was a lower likelihood of hemodynamic insult in subjects with recoarctation after institution of interstage monitoring (63% Era 1, 38% Era 3), but this was not statistically significant ( p =0.06). The proportion of subjects with ventricular dysfunction at intervention decreased significantly ( p =0.002). Rates of technical success, procedural major adverse events, and transplant-free survival did not differ ( p &gt;0.05). Conclusions: Interstage monitoring was associated with increased referral for catheterization but was balanced by a decreased likelihood of hemodynamic insult in subjects with recoarctation. Future study is needed to optimize interstage monitoring strategies for early detection of recoarctation.
Abstract 14861: Decisional Factors Affecting Genetic Testing Uptake Among Black Adults With Hypertrophic Cardiomyopathy
Authors: Milla E Arabadjian, agnes wong, Maria Reuter, Woon Wu, Daniele Massera, Mark Sherrid, Bradley E Aouizerat, Victoria V Dickson
Journal: Circulation (2022)

Introduction: Black adults are underrepresented in hypertrophic cardiomyopathy (HCM) research and experience disparities in HCM - related variant interpretation due to a lack of diversity in genomic reference databases. This is compounded by lower HCM genetic testing utilization among this population. The objective of the qualitative study was to explore decisional factors affecting genetic testing use among a sample of Black adults with HCM. Methods: We used purposive sampling to recruit adults with clinical HCM and had undergone clinical genetic testing for HCM, self-identified as Black/African American, and were receiving care at a large urban academic center. Semi-structured individual interviews were conducted and inductive qualitative content analysis was performed to identify themes related to decisional factors for HCM genetic testing utilization. Quantitative descriptive analysis included demographics and genetic literacy evaluation via the Rapid Estimate of Adult Literacy in Genetics (REAL-G) Results: The sample included 30 individuals (15, 50% women), mean (SD) age 48.8 (17.2) years. Ten (33.3%) individuals had likely-pathogenic/pathogenic variants on clinical genetic testing. REAL-G scores were median (IQR) 62.5 (61;63), signifying a high-school literacy level. Almost half (46.7%) of participants reported finding at least some difficulty paying for basic necessities. The most common themes in decision-making regarding genetic testing utilization included out-of-pocket test costs and a positive relationship with HCM providers, followed by self-care and family concerns. Additional themes emerged concerning individual paths to an HCM diagnosis, including seeing multiple providers and navigating layers of the healthcare system, prior to evaluation by an HCM specialist. Conclusions: This study identified decisional facilitators regarding genetic testing use among a cohort of Black adults with HCM. Future work may focus on identifying barriers and designing interventions to improve genetic testing utilization in this population.
Abstract 13507: Early Diastolic Strain Rate Before Coronary Artery Bypass Grafting Predicts Atrial Fibrillation Following Hospital Discharge
Authors: Mats C Lassen, soeren Lindberg, Flemming J Olsen, Thomas Fritz-Hansen, Sune H Pedersen, Allan Iversen, soeren galatius, Rasmus Mogelvang, Tor Biering-Srensen
Journal: Circulation (2022)

Introduction: Early mitral inflow velocity indexed to early diastolic strain rate (E/e’sr) is a novel echocardiographic parameter to non-invasively estimate early left ventricular (LV) filling pressure. Hypothesis: E/e’sr is associated with development of atrial fibrillation (AF) following coronary artery bypass grafting (CABG) and that it is superior to the conventionally used E/e’, as E/e’sr reflects the global relaxational properties of the LV whereas E/e’ only considers the myocardial movement at the level of the mitral annulus. Methods: A cohort of 623 consecutive patients undergoing isolated CABG at a single center was included. Prior to the CABG procedure, all patients had an echocardiography performed including two-dimensional speckle tracking (2DSTE). The outcome was incident AF after hospital discharge. Cox hazard regression models were used to assess the association between E/e’sr and incident AF. Restricted cubic splines were used to assess linearity of the relationship between E/e’sr and AF. Results: The mean age of the cohort was 67±9 years, 84% were male and mean left ventricular ejection fraction (LVEF) was 50±11%. During follow-up (median: 3.7 years, IQR: 2.6, 4.9) a total of 67 patients (11%) developed AF. E/e’sr and E/e’ were both significantly associated with the outcome in univariable models (p=0.029 and p=0.006, respectively). Increasing E/e’sr was found to be linearly associated with an increased risk of AF ( Figure ). Following multivariable adjustment for age, sex, hypertension, diabetes, EuroSCORE II, serum cholesterol, smoking status, heart rate, number of culprit arteries, LVEF, LV mass index, and left atrial volume index, E/e’sr remained significantly associated with AF (HR:1.06 [1.01-1.12], p=0.038, per 10cm increase) whereas E/e’ did not (HR:1.05 [0.99-1.11], p=0.068, per 1 unit increase). Conclusions: Preoperative E/e’sr as measured by 2DSTE was found to be independently associated with development of AF following CABG.
Abstract 12737: Baseline Carotid Sinus Massage in the Supine Position Predicts Outcome of Head Up Tilt Table Testing: Potential for Abbreviating the Tilt Table Test Protocol
Authors: Atul Prakash, Julie Truong, Milana Nathans
Journal: Circulation (2022)

Introduction: Carotid sinus massage (CSM) has been used to evaluate carotid sinus hypersensitivity. Its role in evaluating a vasodepressor response has not been well studied. CSM can also result in a vasodepressor response in the absence of significant bradycardia. Its role in predicting the subsequent outcome of head-up tilt testing (HUT) is not well defined. Hypothesis: A vasodepressor response elicited with baseline carotid sinus massage (CSM) may predict the subsequent outcome of HUT. Methods: In this prospective study Consecutive patients with a history suggestive of a reflex neurocardiogenic etiology underwent HUT. Patients underwent HUT testing using a standard protocol, including baseline CSM in the supine posture followed by HUT testing at 60 degrees for 30 minutes. If negative, a repeat of CSM was performed in the upright posture. Then, isoproterenol was infused in incremental dose 1 to 3 mcg/minute. Results: 25 patients (20 females and 5 males) with a mean age of 52.87±6.77 years underwent HUT. 5 out of 25 (20%) patients had a positive tilt result for a vasodepressor response. 4 of these 5 patients had a significant vasodepressor response (symptomatic hypotension BP drop less than 30 mmHg) without significant bradycardia (HR less than 50 BPM) during CSM in the supine posture. Of these patients, 3 patients became positive during HUT and 1 patient became positive during isoproterenol infusion. The positive predictive value was 0.8. Sensitivity was 67%. 20 out of 25 (80%) patients had a negative tilt result for a vasodepressor response despite protocol completion. 18 of these 20 patients had no drop in BP during CSM and no significant bradycardia. The negative predictive value was 0.9. The specificity was 94.74%. 2 of these patients had a negative response on CSM but a borderline response at HUT with borderline symptoms with the isoproterenol. These 2 had a transient drop in BP when CSM was repeated at the end of 30 minutes during the head-up position. Conclusions: In this population of patients, a negative CSM in the supine posture predicted a subsequent negative Tilt test. Baseline CSM can be performed at the bedside and may obviate the need for full tilt table testing even for patients with a clinical diagnosis of reflex syncope (vasodepressor).
Abstract 13618: Day Time vs Night Time Extubation After Elective Tetralogy of Fallot Repair
Authors: Jonathan Smerling, Aparna Kulkarni
Journal: Circulation (2022)

Background: Daytime extubation post cardiac surgery has been associated with improved hospital outcome in adults. However, data in pediatrics are lacking. We hypothesized that daytime extubations are associated with shorter critical care time (CCT) and investigated the NIH/NHLBI Pediatric Heart Network Collaborative Learning Study (PHN CLS) open database with this goal. Methods: The PHN CLS was designed as a quality improvement project to implement early extubation guidelines in patients (pts) with Tetralogy of Fallot (ToF) and coarctation of the aorta across 10 centers. We included all ToF pts who had complete repair and excluded pts with coarctation, significant comorbidities and who were a part of the clinical practice guideline. Time to extubation (TTE) was assessed by duration and as day (8 am - 5 pm) vs. night (5 pm - 8 am). CCT was defined as the number of hours from ICU handoff to time the pt was medically ready to leave the ICU. Two sample t-tests were used to compare CCTs between day and night extubations. The relationship of TTE in hours and CCT was assessed using linear regression analysis. A sensitivity analysis was performed after exclusion of pts &gt; median CCT of 50 hours. Results: A total of 144 pts (mean age 155 days, range 28-365 days; 59% males) were included. There was no difference in mean CCT for day (n=70) vs. night (n=74) extubations (104.3 + 18.8 vs. 76.0 + 9.2 hrs, p= 0.17). Overall, there was a strong correlation between TTE and CCT (r 2 0.88, p&lt;0.001), for day extubations (r 2 0.94, p&lt; 0.001) and night extubations (r 2 0.75, p&lt;0.001). On the sensitivity analysis at &lt;50 hours CCT, there was no difference in the mean CCT time for the day (n=30) vs. night (n=32) extubations (36.5 + 2.0 vs. 33.9 + 2.1 hrs, p= 0.39). Day extubations continued to have moderate correlation with CCT in &lt;50 hrs (r 2 0.57, p&lt;0.001) with a weaker correlation for the night group (r 2 0.34, p&lt;0.001). There were 5 reintubations in the overall cohort (3.5%), 1 from the day (0.7%) and 4 from the night (2.8%). Conclusions: In this PHN CLS selective cohort of pts with ToF, our findings suggest that daytime vs nighttime extubation did not affect CCT. We also confirmed that those extubated earlier had shorter CCT. Further study into expanded pt groups is needed to assess impact on outcomes.
Abstract 14403: Hospital- and Patient-Level Quality Indicators for Acute Coronary Syndrome Using Nationwide Database
Authors: Koshiro Kanaoka, Yoshitaka Iwanaga, michikazu nakai, Yuichi Nishioka, Tomoya Myojin, Katsuki Okada, Tatsuya Noda, Yasushi Sakata, Tomoaki Imamura, Yoshihiro Miyamoto
Journal: Circulation (2022)

Introduction: The efficacy of the quality indicators (QIs) using administrative data was unclear. Hypothesis: The use of QIs is associated with lower mortality in patients with acute coronary syndrome (ACS) at both hospital and patient levels. Methods: Patients with ACS who underwent percutaneous coronary intervention (PCI) between April 2014 and March 2018 in the National Database of Health Insurance Claims and Specific Health Checkups of Japan were included. Twelve quality indicators (QIs) were extracted from the administrative data and the association of the QIs with all-cause mortality was investigated. Results: A total of 221,267 patients from 1,220 hospitals were analyzed. The adherence to PCI on admission day, aspirin use on arrival, P2Y12 inhibitor use, and left ventricular function assessment was high (median proportion &gt;90%), and adherence to outpatient cardiac rehabilitation was low (median proportion &lt;10%) among all the QIs. Higher acute phase composite QI score was associated with reduced risk-adjusted 30-day mortality at hospital level (β=-0.92 [95% confidence interval -1.19 to -0.66], P&lt;0.001). Four acute-phase and six subacute-phase QIs were inversely associated with 30-day and long-term mortalities at patient-level, respectively (all P&lt;0.001). Conclusions: There were substantial variations in the care of ACS in the current nationwide database. A higher adherence to the QI sets was associated with survival gains at both hospital and patient levels. Multilevel approach using QI may be effective for improvement of survival among these populations.
Abstract 13740: Cumulative Social Disadvantage and Cost-Related Medication Non-Adherence Among US Adults With Hypertension: The National Health Interview Survey 2014-2017
Authors: Onoriode Kesiena, Kobina Hagan, Reed Mszar, Syed Hyder, Omar M Makram, Shubham Lahan, Isaac Ogunmola, Shreyas Singireddy, Kofi Seffah, Tarang Parekh, Tamer Yahya, Miguel Cainzos-Achirica, Jonathan Murrow, Khurram Nasir
Journal: Circulation (2022)

Introduction: Less than 50% adherence is reported 1 year after initiating antihypertensives. We examined social disparities in cost-related medication non-adherence (CRN) by insurance and family income categories in adults with hypertension. Methods: We used National Health Interview Survey 2014-2017 data from adults who reported hypertension and were taking antihypertensive medications. Respondents reported their insurance plan and family income. A cumulative SDoH index was created by aggregating 45 determinants from 6 domains, and respondents were grouped by quartiles (SDoH-Q1 to Q4). Higher SDoH quartiles indicated greater disadvantage. CRN was present if an individual skipped medication to save money, took less medicine to save money, or delayed filling a prescription to save money in the last 12 months. Results: A total of 35,893 adults managed for hypertension were surveyed, with a mean age 62.48 [SD 14.24] years, female 51.3%). The prevalence of CRN was 9.5%. The uninsured (34.6%) and those with low income were most likely to report CRN. Regardless of insurance or income, higher SDoH quartile groups were more likely to report CRN. This trend was accentuated among the uninsured and the middle-income group. Adjusting for demographics and comorbidities, the least increment in the odds of CRN with SDoH quartiles was seen among Medicare beneficiaries and low-income: SDoH-Q4 was associated with OR = 8.47 (95%CI, 2.11, 33.93) for Medicare beneficiaries, and OR = 17.80 (95%CI, 7.91, 40.03) for low-income. The highest increment in the odds of CRN with SDoH quartiles were observed with the uninsured (OR = 22.89; 95%CI [4.91, 106.81]), and the middle-income group (OR = 21.57; 95%CI [13.78, 33.77]). Conclusion: While cumulative social disadvantage was associated with higher cost-related medication non-adherence among adults on medications for hypertension, this association was stronger in the uninsured, Medicaid beneficiaries, and the middle-income group.